Sleep Apnea Syndrome in a Referral Population in Greece: Influence of Social Factors

The aim of this work was to study whether social factors are risk factors for obstructive sleep apnea (OSA). A second objective was to investigate gender differences in relation to referral to a sleep laboratory for sleep-related breathing symptoms.

A retrospective cross-sectional study was conducted in the referral sleep disorders laboratory in the tertiary University Hospital in Patras in southwest Greece. A sample of 362 subjects originated from this geographic region was screened for social characteristics, i.e., marital status, occupation, and education.

The apnea hypopnea index (AHI) was approximately three times as high in men as in women (p < 0.05). Snoring was reported to be a symptom by 76.6% of males and 75% of females. Excessive daytime sleepiness (EDS) was reported by 25.5% of males and 15% of females. Arousals during sleep were reported by 5.7% of men and 10% of women. The ratio of subjects with concomitant disorders or symptoms did not differ between sexes (p > 0.05). The influence of age, body mass index (BMI), gender, smoking, and social characteristics on AHI was examined by multinomial logistic regression. The following factors remained independent risk factors for the presence of moderate to severe OSA (i.e., AHI > 15/h compared with AHI < 5): (1) Gender: the odds ratio (OR) of males to females was 6.23 (CI = 1.89–20.5). (2) Obesity: the OR of subjects with BMI >30.5 kg/m² in comparison to those with lower BMI was 3.83 (CI = 1.86–7.86). (3) Marital status: The OR of married subjects to singles was 2.30 (CI = 1.01–5.32). (4) Occupational status: The OR of subjects outside the work force was 3.85 (CI = 1.16–12.74) and that of the self-employed was 1.70 (CI = 0.70–4.10) compared to a reference group of clerks/employees.

In our study factors associated with the presence of sleep apnea include gender (men), obesity, marriage, and self-employment or being outside the work force.